Seniors Show Their Muscle in Fight Against Healthcare Fraud

Last year, the federal government ramped up its efforts to get seniors involved in the fight against Medicare fraud. One year later, the seniors have proven themselves worthy opponents against those attempting to defraud the government via Medicare schemes. This week, Kathleen Sebelius, Director of HHS, announced that seniors have become one of the most valuable resources when finding evidence of health care fraud, announcing that the Obama Administration is investing more than $7 million in new funding to support the Senior Medicare Patrol in various projects around the country.

According to Sebelius, “seniors are paying attention and they are fighting back against the fraudsters who are trying to steal from Medicare.” It is often seniors who notice services they never received on their Medicare statements who provide the first tip that fraud is happening. As a result, CMS has redesigned Medicare statements to make them easier to read and understand. Senior Medicare Patrol (SMP) programs are educating seniors, family members, and caregivers around the country about the importance of reviewing their Medicare notices to identify errors and report potentially fraudulent activity.

Sebelius noted stories such as one about a Medicare beneficiary in Texas who was asked to sign a work order for his diabetes supplies. According to Sebelius, the gentleman that, “normally he would have just signed and thrown the paper away. But he had recently heard a presentation from the SMP at his adult day center, so he looked more closely and noticed that he was being charged $7,000 for one month’s supply. So he asked his home nurse to help him call the National Hispanic SMP and together they figured out that the supplier was going to charge Medicare for 100 boxes of diabetes test strips and 100 boxes of lancets, even though he’d received only one of each. The SMP helped resolve the case and made sure that Medicare only paid for the supplies he actually needed and received.”

Cases like that are all too common. It is incredibly important to educate seniors on what to look for and how to pay attention. The SMP pays for many classes each year so that seniors may be trained to spot and report questionable items. In fact, much of the money coming in from the government is being allocated toward education. According to the stop Medicare fraud website, “educating and empowering health care consumers to prevent fraud is an essential strategy for protecting our citizens and their health benefits and strengthening Medicare and Medicaid.”And how are we sure? The OIG has reported that this program works. According to a recent OIG report released in June, in 2011, the SMP realized a 14-percent increase in the number of volunteers over the year before, bringing the total to almost 5,700. In just the past couple of years, the SMP saw a 45-percent increase in the number of Medicare beneficiaries who attended group education sessions, from 298,097 in 2010 to 431,128 in 2011.

Although some of SMP’s efforts have experienced only modest results, about $19,283 in Medicare funds were recovered in 2011 and cost avoidance totaled $247,850, SMP members have also taken part in reporting two “large-dollar cases” to contractors. In one case, the Medicare contractor is seeking to recover $2.9 million in overpayments from a provider, the OIG report stated.

To date, more than 1.5 million seniors have called SMP programs in cities around the country to ask questions and report potential fraud. And together they’ve saved Medicare and the federal government in excess of $100 million. And $100 million return on a $7 million investment isn’t too terrible.